The present invention pertains generally to medical and surgical tube holding devices, and more particularly to devices for anchoring a tube, such as a catheter, in position relative to a patient's body.
Many medical or surgical treatments necessitate the provision of an unobstructed passageway into a patient's body. Typically, such a passageway is provided by installing one or more tubes into the body. In some situations, the tube or tubes passes through the skin of the patient. In other situations, the tube enters the patient's body at a natural orifice. In both situations, the problem of anchoring or holding the tube to the patient's body must be addressed. Two general approaches are known: internal anchor systems and external anchor systems. By anchor system herein is meant at least two attachments, an attachment to a patient and an attachment to the tube. Additionally, anchor systems may involve a link between the two attachments.
U.S. Pat. No. Pat. No. 4,156,428 shows an example of an internal anchor system: specifically, an expansive cuff on the tube is inflated to create an anchor region within a patient's trachea.
With respect to external anchor systems, several variations are known. In one approach, the tube is directly secured to the patient by suturing the tube to the body, as shown in the H'Doubler, U.S. Pat. No. 3,176,690, or the Sheridan, U.S. Pat. No. 3,777,690, patents. Although suturing provides a secure attachment with respect to both the patient's body and the tube, it is difficult to interchange or readjust the tube. In the particular case of naso-gastric catheter, suturing the tube to the patient's face or nose is particularly objectionable.
One alternative to a suture attachment to the patient involves mechanical encircling of a portion of the patient's body. The Roxburg patent U.S. Pat. No. 4,527,559 discloses an anchoring of an endotracheal tube by the use of twill tape tied about a patient's neck. Anchoring systems which avoid suture attachments to the patient also generally employ an alternative attachment to the tube. The Roxburg endotracheal tube includes transverse apertures through which the twill tape is threaded to provide a secure attachment to the tube.
The Foster, U.S. Pat. No. 4,331,143, Carroll, U.S. Pat. No. 4,844,061 and Smith U.S. Pat. No. 4,592,351 patents show patient attachments involving encircling the patient's head with straps. In these three patents, adhesive attachments are used to secure the tube in the anchor system.
The attachment to the patient can also entail an adhesive attachment. Examples of adhesive attachments to patients in regards to anchoring a tube are shown in Lund U.S. Pat. No. 3,288,136, Kraviec U.S. Pat. No. 3,146,778, Kalt U.S. Pat. No. 4,838,878, Beisang U.S. Pat. No. 4,823,789, Page U.S. Pat. No. 3,782,388, Coleman U.S. Pat. No. 3,977,407, Taylor U.S. Pat. No. 4,057,066, and Moor U.S. Pat. No. 4,120,304. Initial adhesive attachments to a patient are typically satisfactory. However, if the adhesive attachment to the patient's skin must be repeatedly removed and replaced, the patient's skin can become very sore and irritated.
Many anchoring systems employing adhesive attachments to a patient include some separation of the attachments to the tube and to the patient. Separation or linking of the attachment point to the tube from the patient is shown in the Foster, Smith, Coleman, and Moor patents. Flexibility in such separation or linking is shown in Page. Flexible links, in the case of naso-gastric catheters, provide a greater level of patient comfort. The Krawiec patent shows a snap attachment system located roughly midway in a flexible link. The snap also contributes some of the flexibility in the Krawiec system. When unsnapped, a portion of the tether adhesively attached to the catheter continues to project from the tube, thus preventing the possibility of further insertion into the patient and also incurring the danger of snagging.
Adhesive attachments to the tube may be a problem after the tube has been in place some time. The adhesive attachment may be weakened by secretions and bodily fluids from the patient. Further, if the tube is to be readjusted relative to the original anchor point, the establishment of a new attachment to the tube may be particularly difficult since the patient's secretions and fluids tend to coat the tube and inhibit formation of new adhesive attachments.
Prior art tube attachments which are alternatives to adhesive include clamp mechanisms such as disclosed in the Lund, Moor, and Page patents. Such alternative attachments are generally objectionable in their tendency to at least partially deform the tube and thereby restrict or reduce the bore of the tube when clamped sufficiently tightly upon the tube to fully prevent any lengthwise tube movement.
Thus there exists a need for a tube anchoring system which allows for the establishment of an initial, semi-permanent, attachment to an external portion of a patient's body and a simple, yet dependable, attachment to a tube. Such a system ideally should incorporate a mechanism for either adjusting or exchanging tubes without disturbing the initial attachment to the patient's body.